Emergency first aid: the knowledge, not the certificate

Cue 1 Warning card at the top: this is not a first aid qualification.

AMARA 00:00 Before anything else. Does this make me a first aider?

NADIA 00:04 No. And I want that at the top rather than in a footnote, because burying it is how people end up believing they are qualified.

AMARA 00:14 What is missing?

NADIA 00:15 Everything requiring hands. Compression depth and rate. Opening an airway. Managing a real collapsed person while frightened. Those have to be practised on a manikin and assessed by an instructor.

AMARA 00:27 Then what is this for?

Cue 2 DRSAB sequence with danger held longest.

NADIA 00:29 The sequence. Because the commonest reason people do nothing in an emergency is not cowardice. It is not knowing what order to do things in, so they stand there.

AMARA 00:40 Give me the order.

NADIA 00:42 Danger. Response. Shout for help. Airway. Breathing. Danger first, always, because a second casualty helps nobody and that is the step adrenaline removes.

AMARA 00:51 Shout for help. Just shout?

NADIA 00:53 No, and this is the detail that changes outcomes. Point at a specific person and name the task. You, in the blue coat, ring 999 and come back and tell me you have done it.

Cue 3 Pointing at one named person to ring 999, versus a general shout in a crowd.

AMARA 01:07 Why so specific?

NADIA 01:08 Because a general shout in a crowd produces nothing at all. Everybody assumes somebody else is already doing it. Naming one person and one task breaks that instantly.

AMARA 01:20 Then airway and breathing.

NADIA 01:21 Head tilt, chin lift. Then look, listen and feel for no more than ten seconds. And here is the thing I most want you to remember from this whole course.

AMARA 01:33 Go on.

Cue 4 Agonal gasping labelled as cardiac arrest.

NADIA 01:34 Agonal gasping is not breathing. In the first minutes of a cardiac arrest people often make irregular, noisy gasps. It looks like breathing to a frightened bystander, and it is the single commonest reason nobody starts CPR on somebody who could have survived.

AMARA 01:51 So gasping means?

NADIA 01:52 Treat it as cardiac arrest. 999, get an AED, start compressions.

AMARA 01:57 Let us do the time critical ones. Stroke.

NADIA 02:00 FAST. Face drooping, Arms cannot stay up, Speech slurred, Time to ring 999. And note the time symptoms started.

Cue 5 FAST with the onset time being written down and handed over.

AMARA 02:08 Why does that matter?

NADIA 02:09 Because treatment options depend on it, and nobody at hospital will know it unless somebody who was there tells them. That one piece of information from a bystander can change what treatment is possible.

AMARA 02:23 Sepsis?

NADIA 02:23 Suspected infection plus deterioration. Slurred speech or confusion, extreme shivering or muscle pain, no urine in a day, severe breathlessness, a feeling of impending death, mottled or discoloured skin.

AMARA 02:35 And I should say the word?

Cue 6 Direct pressure on a wound, with an embedded object packed around rather than removed.

NADIA 02:37 Say the word sepsis out loud when you call. It starts a different pathway. A described patient with an unnamed suspicion does not get the clock started.

AMARA 02:48 Severe bleeding?

NADIA 02:49 Firm direct pressure on the wound, with something clean if you have it and your hand if you do not. Do not pull out anything embedded, pack around it. Lie them down and ring 999.

AMARA 03:03 Last question, and it is the one that stops people. Can I be sued for helping?

NADIA 03:09 That fear prevents far more help than it should. The Social Action, Responsibility and Heroism Act 2015 requires a court to consider whether somebody was acting for the benefit of society and intervening in an emergency.

AMARA 03:24 So what is the sensible position?

NADIA 03:26 Act reasonably, within your competence, and do not attempt things you have not been trained in. Somebody in cardiac arrest is not going to be made worse by a bystander trying. They are dying already.

Cue 1 Direct pressure applied, with an embedded object packed around rather than removed.

AMARA 03:40 Heavy bleeding. What do I actually do?

NADIA 03:43 Firm direct pressure on the wound. Something clean if you have it, your bare hand if you do not. Pressure stops bleeding; a dressing is just a more comfortable way of applying pressure.

AMARA 03:56 There is glass in the wound.

NADIA 03:58 Then leave it. Do not pull it out, because it may be the only thing stopping much heavier bleeding. Pack around it and press either side.

AMARA 04:09 The dressing has soaked through.

Cue 2 A soaked dressing with a second added on top rather than replaced.

NADIA 04:11 Add more on top. Never remove the first one, because you strip off the clot that was forming underneath it.

AMARA 04:19 Both of those feel like the wrong thing to do.

NADIA 04:23 They both feel like helping, and they both increase blood loss. That is why they are worth learning before you are standing over somebody.

AMARA 04:32 Burns. How long do I cool it for?

NADIA 04:36 Twenty minutes under cool running water. Twenty, not a couple, and it is still worth doing up to three hours afterwards.

Cue 3 Twenty minute cooling timer, with the burn still cooking at two minutes.

AMARA 04:44 Twenty minutes is a long time.

NADIA 04:46 It is, and it is the single most effective thing anybody does for a burn. People stop at two minutes because the person says it feels better, and the burn carries on cooking underneath.

AMARA 05:00 Should I take a ring off?

NADIA 05:02 Yes, and quickly, unless it is stuck to the burn. Swelling comes fast and a ring becomes a tourniquet on a finger.

AMARA 05:11 Then cover it?

Cue 4 Ring removed before swelling, and cling film laid on rather than wrapped.

NADIA 05:12 Cling film laid on, not wrapped around, because wrapping constricts as it swells. Or a clean non fluffy cloth. Cling film is ideal: it does not stick, and the wound stays visible.

AMARA 05:25 My grandmother swore by butter.

NADIA 05:27 Your grandmother was wrong, and so is toothpaste, cream and ice. Butter and creams trap heat and get scraped off in hospital, which is as unpleasant as it sounds. Ice causes additional tissue damage. And never burst a blister.

AMARA 05:43 Seizures frighten me. Do I hold them?

NADIA 05:46 No. Do not restrain them, and do not put anything in their mouth. Both are actively harmful.

Cue 5 Seizure: furniture moved, head protected, hands off, clock started.

AMARA 05:52 What about swallowing their tongue?

NADIA 05:54 It does not happen. It is not anatomically possible, and people have broken teeth and fingers acting on that belief.

AMARA 06:02 So what do I do?

NADIA 06:04 Protect their head, move the furniture, note the time it started, and stay with them. When it stops, recovery position, and let them come round in their own time. Confusion and exhaustion afterwards are normal and they may not know where they are.

AMARA 06:22 When do I call 999?

Cue 6 Choking: five back blows, five abdominal thrusts, alternating.

NADIA 06:24 More than five minutes. Another one before they have recovered. Their first ever. If they are injured. Or if they do not regain consciousness.

AMARA 06:33 Choking. Back blows first?

NADIA 06:35 If the cough is ineffective, yes. Five back blows between the shoulder blades, then five abdominal thrusts, alternating. Unresponsive, start CPR.

AMARA 06:43 And if they are coughing well?

NADIA 06:46 Leave them to it and encourage it. A person coughing forcefully is moving far more air than you will move for them, and interfering can turn a partial obstruction into a complete one.

AMARA 06:59 Afterwards?

NADIA 06:59 Anyone who has had abdominal thrusts gets medical assessment, even if they feel completely fine, because of the risk of internal injury.